Liver Transplant at the Penn Transplant Institute

Who needs a liver transplant?

At this time, transplantation is the only cure for liver failure because no device or machine reliably performs all of the functions of the liver. People who require liver transplants have acute liver failure but more typically chronic liver failure.

Acute liver failure occurs when a previously healthy liver suffers injury resulting in liver insufficiency. In chronic liver failure there has been repeated injury and repair to the liver, typically over many years. Chronic liver failure can be caused by viral hepatitis, autoimmune diseases, alcohol abuse, obesity, metabolic conditions, genetic liver diseases, liver cancer or other disease. This permanent and end stage of scarring is termed cirrhosis, and the liver can no longer repair itself. Medications can decrease the symptoms caused by the liver failure, but liver transplantation is the only permanent cure.

Can patients with liver cancer get a liver transplant?

Primary liver cancer, or hepatocellular carcinoma (also called hepatoma or HCC) is one of the major reasons for liver transplantation in the United States. Patients with HCC that is detected early enough for transplant are evaluated for liver transplantation similar to other patients, with additional careful evaluation of the extent of tumor. Transplant candidates with HCC are then placed on the liver transplant waiting list. Additional treatments are often needed while the patients wait on transplant.

A major advantage of transplantation for HCC is that it results in complete removal of the cirrhotic liver that could harbor additional HCC tumors or develop new tumors in the future. For this reason, the chance of cancer recurrence after treatment is lower in patients who receive a liver transplant compared to patients who receive surgical resection as the curative treatment for HCC.

How long is the wait for a liver transplant?

The waiting time for an organ has increased dramatically as the demand for livers far outweighs the supply. Because of the high risk of death for patients with end-stage liver disease while waiting on the list, the United Network for Organ Sharing (UNOS) has developed a scoring system based on several factors, the most important is severity of illness. Other factors include blood type, the number of other patients listed within the local area and the region.

How does the wait list for a liver transplant work?

The MELD (Model for End-Stage Liver Disease) score was developed by the United Network of Organ Sharing (UNOS) to determine the severity of disease for patients waiting on a liver transplant. The MELD score ranges from 6 to 40 - with the most gravely ill patients having the highest numbers.

An easy way to think about the MELD score is: the MELD score is how sick the liver is, and the sicker the liver is, the higher the number, which means you are closer to transplant. Race, sex or ethnic background play no role in determining allocation of organs. A person’s spot on the waiting list depends on the availability of organs, the patient’s blood type and medical urgency as reflected by their MELD score.

Can someone travel while on the liver transplant waiting list?

Many patients can travel safely. However, they are advised to ask their doctor and inform the transplant coordinator of their destination, contact address and phone numbers before they leave.

How successful is liver transplantation?

Liver transplantation at Penn Medicine is very successful, and our patient outcomes are the best in the region. Most people are able to return to their daily routine within three months after the transplant, and many of them even earlier. Recipients have been known to live a normal life 30 years after the operation. Transplant success depends on a number of variables, including health status at the time of transplant, age and recurrent disease. Transplant recipients also directly contribute to the success of their transplant.

The number one cause of organ failure following a transplant is due to patients not following the prescribed immunosuppression medication regimen. Careful attention to medication schedules, lifestyle changes, infection-avoidance techniques and close follow-up with with your transplant team and primary care physician can help ensure a good outcome.

What are the major risks in liver transplantation?

With liver transplant surgery, the risks are those that are common to all forms of major surgery or relate to technical difficulties in removing the diseased liver or implanting the donor liver. Immediately after the operation, risks include bleeding, poor function of the grafted liver, bile leaks and infections. We monitor the patient carefully for several weeks after surgery for rejection. Rejection becomes less common with time.

What is the recovery time after liver transplant?

Recovery after liver transplantation depends in part on how ill the patient was prior to surgery. Most patients are hospitalized for seven to 10 days after liver transplant. Afterward, they generally recuperate at home and typically return to work or school after about three months.

How frequent is the medical follow-up care after liver transplantation?

During the first six weeks after liver transplantation, patients will have frequent blood tests and other exams to monitor liver function and detect any evidence of rejection or infection in the new liver. Longer term patients are asked to return for check-ups about once or twice a year.

Can I return to work and be physically active after receiving a liver transplant?

Most patients can return to a normal or near-normal activity and participate in fairly vigorous exercise six to 12 months after successful liver transplant surgery. Often, we let patients return to work and drive as little as two to three months after liver transplantation.

Is receiving a liver donated by a living friend or family member an option?

Yes, living liver donation is an option that can be discussed with your surgeon and hepatologist. Not all Transplant Centers offer this option. Penn Medicine has been performing living donor liver transplants for over 20 years. In the United States, more than 17,500 patients are on the waiting list to receive a liver transplant making the wait for a deceased donor liver very long for many people on the list. Due to a shortage of organs, at least 1,700 patients die each year waiting for a liver transplant. Living donation significantly decreases the time a patient has to wait for a liver on the wait list, and so can get them to transplant prior to getting very sick. Livers from living donors are usually of excellent quality because donors are carefully evaluated prior to donation and are only allowed to donate if they are in very good health. Learn more about living donor liver transplant.